Should I Get A Flu Shot?

Earlier this week in conversation with a friend, I emphatically said I would never get a flu shot. This in spite of the fact my husband seems to have had a mercifully short but very intense bout of the stomach flu recently. And in spite of the fact that I’ve had the real, full blown flu myself, though not in many years.

My husband’s case we have attributed to travel on business to Florida, Ohio, Indiana, Iowa and Wisconsin in the two weeks immediately prior to succumbing. No, he did not get tested so we are unable to confirm if it was the true flu, a touch of food poisoning or some other, random though particularly nasty stomach bug.

He was at trade shows, in contact with people from all over the country and even international visitors. He was on ten different flights in less than two weeks, and we all know that being enclosed for hours on an airplane is one of the flu’s favorite incubators. Now add in the airports, hotels, restaurants and all the other public places, and there is no way for us to know how or when he caught whatever it was.

But, since I did not catch it after him, (yes, we were pretty careful not to spread whatever it was, washing hands and everything he touched), we tend to think it was something food borne. Still, I’ve been re-thinking my anti-flu shot stance, in light of other information I just came across.

Any thinking, rational person should be afraid of getting the flu, particularly the variant that is running around this season. It is not at epidemic proportions, at least not yet. But all the factors are in place, ready to make this flu season very, very bad.

In the San Francisco Bay area, one hospital is setting up tents outside to handle the influx of people coming in with symptoms. This is not because the hospital is overflowing, again yet, but simply to contain and minimize the risk of spreading the virus. Closer to home, Suburban Chicagoland and Illinois have just been raised to the “widespread” category, the highest level on the CDC chart. The most important part of that piece of information is that we spiked from the relatively minor “localized” category to this highest level in one week.

Some of the factors that contribute to outbreaks of influenza are dry air and close quarters contact with lots of people. The record cold arctic air that is finally leaving us was unusually dry, even for winter air. The air was so dry in part because it is so cold any moisture in the air crystallized, meaning it could be snowing and considered dry at the same time. Couple that with the cranked up furnaces to warm -and and further dry -  the air, even whole-house humidifiers can't sufficiently moisten the air to create a less than hospitable environment for the flu bug. 

With these very cold temperatures, people stayed home. School was cancelled. Businesses and government offices were closed. Which means not much opportunity for transmission of the virus. But that is all about to change with this weekend’s forecast of predicted temperatures in the high 30’s for the next few days. After today’s probable rains, it will again be dry as well. Because it is the weekend, people who had been housebound earlier in the week will be heading out to stores, shopping, the mall and engaging in lots of other social activities. In other words, a perfect storm for a major influenza outbreak is brewing.

My primary objection to getting a flu shot has been over the effectiveness of each year’s  vaccine against the prevalent strains. This year, that argument is falling flat.

According to the CDC, over 97% of the confirmed cases have been Influenza A, and over half of those cases were subtype H1N1. The vaccines available this year come in two basic varieties, either the trivalent or the quadrivalent. The trivalent vaccine contains three strains, including Influenza A, subtype H1N1, along with the other Influenza A subtype that was most common in 2011 and the Influenza B strain most common last year. The quadrivalent is four strains, the above three with the addition of the B strain most common in 2008.  So, this year’s vaccine is a good match for the types of flu that are landing people in the hospital, in the ICU and have been responsible for the rising number of deaths reported so far this season.

One of the things that make a particular strain more dangerous is who succumbs to the worst of the symptoms. Generally, the very young and the very old and those with otherwise weak or compromised immune systems are most at risk. This year, particularly in California, it is the otherwise healthy, average adult that is ending up in the ICU, or worse. But, thanks to the miracle of modern air travel and an always mobile public, the bug that was in one part of the country this morning can be sitting next to you in a movie theater this evening.

They say it isn’t the flu bug that kills you, just the symptoms, but that is only partly correct. If a strain of the flu is unusually strong, has evolved in new ways or replicates particularly quickly, the bug itself causes a lot of damage on it’s own. Our body's immune system responds to the virus as a foreign invader; if it is taking a large toll on our systems because it is reproducing very fast, our systems are less able to respond to symptoms caused directly by the virus – and the body’s response to the presence of the virus.

Fever is one of those responses of the body that are critical for self-preservation, but uncontrolled or uncontrollable fever can itself be fatal. It is the same with an excessive mucus response, another of the body’s attempts to rid itself of an invader. When mucus production goes into overdrive and it feels as if our noses have become faucets that can’t be turned off, that is a sign that our sinus tissues are overwhelmed and unable to shed virus as fast as it is replicating. Some of that drainage ends up in our lungs, no matter how frequently we blow our nose; within that drainage will be live, active virus.

Now it hits our lungs and our immune system responds there as well, trying to rid our bodies of the drainage, excess secretions produced by our lungs and the virus itself. If the virus takes hold in our lungs or a secondary infection sets in, pneumonia develops. At this point, getting tested makes sense because if the upper respiratory infections are bacterial, antibiotics can help. If it is viral, not only will antibiotics not work, they may make things worse by killing off the good bacteria that helps keep our systems in balance.

Many years ago, I did succumb to the flu. Not flu-like symptoms, but the real deal. As I lay on a mattress on the living room floor with my then four-year-old son on one side of me and my mother on the other, I realized how people die from this bug. We literally spent three days on that mattress on the living room floor, and if my brother had not been bringing food in to us, I don’t know if one or all of us wouldn’t have ended up in the hospital.

I had never been so sick, and so at the mercy of symptoms I could not abate. All the while, when I wanted nothing more than to sleep (when I wasn’t coughing, wretching, alternately shivering and sweating) I kept making myself wake up every hour or so to check on my son. That was when he was able to sleep and not sweating, shivering, wretching or coughing and awake himself. There was a night I seriously considered having my brother take him to the hospital because I could not get his fever down or to stay down. When it finally broke and he slept peacefully for the first time in a couple days, I too feel asleep, crying with relief. Mercifully, he bounced right back and was none the worse for wear.

Memories of that experience, warnings about how bad this year’s flu is and the fact the vaccine out now is a match for the worst variant have me seriously thinking about getting a shot. But, I need to make up my mind soon as it takes two weeks for the vaccine to become effective. And I’ll be going to the store, shopping and attending social functions this weekend, all the places where exposure is most likely. Since I plan on being mostly home next week, if I don’t have any symptoms by Wednesday, which allows for the average two day incubation period, maybe I’ll go get a shot.